心房細動に対するカテーテルアブレーション後に心室細動を生じた低心機能の1例
症例は58歳, 女性. 主訴は動悸・息切れ. 55歳時に初回の心不全で入院. 冠動脈造影検査で有意狭窄なく, 心筋生検でも非特異的な所見のみ. HR 130/分台の頻脈性心房細動を認めたが, 低心機能と低血圧のためβ遮断薬は増量困難であり, rate controlは困難. その後, 一度DCにて洞調律に復帰したが, 2週間後には心房細動が再発・持続した. 心不全の増悪傾向を認め, 心房細動に対しカテーテルアブレーションを施行. アブレーション＋電気的除細動(200J)にて洞調律に復帰したが, 洞調律維持のため, Amiodarone内服を併用. 術翌日, 洞性徐脈と著明なQT延長を認め, R...
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| Published in | 心臓 Vol. 42; no. SUPPL.2; pp. S2_12 - S2_19 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.42.S2_12 |
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| Abstract | 症例は58歳, 女性. 主訴は動悸・息切れ. 55歳時に初回の心不全で入院. 冠動脈造影検査で有意狭窄なく, 心筋生検でも非特異的な所見のみ. HR 130/分台の頻脈性心房細動を認めたが, 低心機能と低血圧のためβ遮断薬は増量困難であり, rate controlは困難. その後, 一度DCにて洞調律に復帰したが, 2週間後には心房細動が再発・持続した. 心不全の増悪傾向を認め, 心房細動に対しカテーテルアブレーションを施行. アブレーション＋電気的除細動(200J)にて洞調律に復帰したが, 洞調律維持のため, Amiodarone内服を併用. 術翌日, 洞性徐脈と著明なQT延長を認め, R on TのPVCから心室細動となり, 電気的除細動(200J)にて蘇生. 一時的ペーシングカテーテルによる高頻度心房ペーシングを施行し, 以後心室細動の出現. 拡張型心筋症の可能性も否定できず, 植込み型除細動器(ICD)植え込み術施行. 以後, 洞調律または心房ペーシングにて経過し, 心房細動の再発や心室細動の出現は認めず. |
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| AbstractList | 症例は58歳, 女性. 主訴は動悸・息切れ. 55歳時に初回の心不全で入院. 冠動脈造影検査で有意狭窄なく, 心筋生検でも非特異的な所見のみ. HR 130/分台の頻脈性心房細動を認めたが, 低心機能と低血圧のためβ遮断薬は増量困難であり, rate controlは困難. その後, 一度DCにて洞調律に復帰したが, 2週間後には心房細動が再発・持続した. 心不全の増悪傾向を認め, 心房細動に対しカテーテルアブレーションを施行. アブレーション＋電気的除細動(200J)にて洞調律に復帰したが, 洞調律維持のため, Amiodarone内服を併用. 術翌日, 洞性徐脈と著明なQT延長を認め, R on TのPVCから心室細動となり, 電気的除細動(200J)にて蘇生. 一時的ペーシングカテーテルによる高頻度心房ペーシングを施行し, 以後心室細動の出現. 拡張型心筋症の可能性も否定できず, 植込み型除細動器(ICD)植え込み術施行. 以後, 洞調律または心房ペーシングにて経過し, 心房細動の再発や心室細動の出現は認めず. |
| Author | 西村, 重敬 原, 幹 加藤, 律史 小宮山, 伸之 飛梅, 威 上西, 正洋 石田, 仁志 堀田, ゆりか 松本, 万夫 |
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| References | 3) Vrtovec B, Delgado R, Zewail A, et al: Prolonged QTc interval and high B-type natriuretic peptide levels together predict mortality in patients with advanced heart failure. Circulation 2003; 107: 1764-1769 11) Di Micoli A, Zambruni A, Bracci E, et al: “Torsade de pointes” during amiodarone infusion in a cirrhotic woman with a prolonged QT interval. Dig Liver Dis 2009; 41: 535-538 13) Varro A, Virag L, Papp JG: Comparison of the chronic and acute effects of amiodarone on the calcium and potassium currents in rabbit isolated cardiac myocytes. Br J Pharmacol 1996; 117: 1181-1186 17) Kodama I, Kamiya K, Honjo H, et al: Acute and chronic effects of amodarone on mammalian ventricular cells. Jpn Heart J 1996; 37: 719-730 7) Tsuji Y, Opthof T, Yasui K, et al: Ionic mechanisms of acquired QT prolongation and torsades de pointes in rabbits with chronic complete atrioventricular block. Circulation 2002; 106: 2012-2018 19) Aiba T, Shimizu W, Inagaki M, et al: Cellular and ionic mechanism for drug-induced long QT syndrome and effectiveness of verapamil. J Am Coll Cardiol 2005; 45: 300-307 10) Antonelli D, Atar S, Freedberg NA, et al: Torsade de pointes in patients on chronic amiodarone treatment. Isr Med Assoc J 2005; 7: 163-165 12) Lim HE, Pak HN, Ahn JC, et al: Torsade de pointes induced by short-term oral amiodarone therapy. Europace 2006; 8: 1051-1053 18) Capparo R, Calkins H, Chen SA, et al: Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. 2009; 53: 1798-1803 8) Volders PGA, Sipido KR, Vos MA, et al: Downregulation of delayed rectifier K+ currents in dogs with chronic complete atrioventricular block and acquired torsades de pointes. Circulation 1999; 100: 2455-2461 15) Kodama I, Kamiya K, Toyama J: Cellular electrophysiology of amiodarone. Cardiovasc Res 1997; 35: 13-29 16) Kiehn J, Thomas D, Karle CA, et al: Inhibitory effects of the class III antiarrhythmic drug amiodarone on cloned HERG potassium channels. Naunyn Schmiedebergs Arch Pharmacol 1999; 359: 212-219 4) Tsuji Y, Zicha S, Qi XY, et al: Potassium channel subunit remodeling in rabbits exposed to long-term bradycardia or tachycardia. Circulation 2006; 113: 345-355 6) Grom A, Thomas S, Faber S, et al: Delayed adaptation of ventricular repolarization after sudden changes in heart rate due to conversion of atrial fibrillation. Europace 2005; 7: 113-121 9) Suto F, Zhu W, Chan A, et al: IKr and IKs remodeling differentially affects QT interval prolongation and dynamic adaptation to heart rate acceleration in bradycardiac rabbits. Am J Physiol Heart Circ Physiol 2007; 292: H1782-H1788 1) Tsuji Y, Opthof T, Kamiya, et al: Pacing-induced heart failure causes a reduction of delayed rectifier potassium currents along with decreases in calcium and transient outward currents in rabbit ventricle. Cardiovasc Res 2000; 48: 300-309 5) Geelen P, Brugada J, Andried E, et al: Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. Pacing Clin Electrophysiol 1997; 20: 343-348 14) Kamiya K, Nishiyama A, Yasui K, et al: Short- and long-term effects of amiodarone on the two components of cardiac delayed rectifier K+ current. Circulation 2001; 103: 1317-1324 2) Rose J, Armoundas AA, Tian T, et al: Molecular correlates of altered expression of potassium currents in failing rabbit myocardium. Am J Physiol Heart Circ Physiol 2005; 288: H2077-H2087 |
| References_xml | – reference: 1) Tsuji Y, Opthof T, Kamiya, et al: Pacing-induced heart failure causes a reduction of delayed rectifier potassium currents along with decreases in calcium and transient outward currents in rabbit ventricle. Cardiovasc Res 2000; 48: 300-309 – reference: 14) Kamiya K, Nishiyama A, Yasui K, et al: Short- and long-term effects of amiodarone on the two components of cardiac delayed rectifier K+ current. Circulation 2001; 103: 1317-1324 – reference: 10) Antonelli D, Atar S, Freedberg NA, et al: Torsade de pointes in patients on chronic amiodarone treatment. Isr Med Assoc J 2005; 7: 163-165 – reference: 18) Capparo R, Calkins H, Chen SA, et al: Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. 2009; 53: 1798-1803 – reference: 5) Geelen P, Brugada J, Andried E, et al: Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. Pacing Clin Electrophysiol 1997; 20: 343-348 – reference: 12) Lim HE, Pak HN, Ahn JC, et al: Torsade de pointes induced by short-term oral amiodarone therapy. Europace 2006; 8: 1051-1053 – reference: 17) Kodama I, Kamiya K, Honjo H, et al: Acute and chronic effects of amodarone on mammalian ventricular cells. Jpn Heart J 1996; 37: 719-730 – reference: 2) Rose J, Armoundas AA, Tian T, et al: Molecular correlates of altered expression of potassium currents in failing rabbit myocardium. Am J Physiol Heart Circ Physiol 2005; 288: H2077-H2087 – reference: 9) Suto F, Zhu W, Chan A, et al: IKr and IKs remodeling differentially affects QT interval prolongation and dynamic adaptation to heart rate acceleration in bradycardiac rabbits. Am J Physiol Heart Circ Physiol 2007; 292: H1782-H1788 – reference: 16) Kiehn J, Thomas D, Karle CA, et al: Inhibitory effects of the class III antiarrhythmic drug amiodarone on cloned HERG potassium channels. Naunyn Schmiedebergs Arch Pharmacol 1999; 359: 212-219 – reference: 11) Di Micoli A, Zambruni A, Bracci E, et al: “Torsade de pointes” during amiodarone infusion in a cirrhotic woman with a prolonged QT interval. Dig Liver Dis 2009; 41: 535-538 – reference: 6) Grom A, Thomas S, Faber S, et al: Delayed adaptation of ventricular repolarization after sudden changes in heart rate due to conversion of atrial fibrillation. Europace 2005; 7: 113-121 – reference: 19) Aiba T, Shimizu W, Inagaki M, et al: Cellular and ionic mechanism for drug-induced long QT syndrome and effectiveness of verapamil. J Am Coll Cardiol 2005; 45: 300-307 – reference: 3) Vrtovec B, Delgado R, Zewail A, et al: Prolonged QTc interval and high B-type natriuretic peptide levels together predict mortality in patients with advanced heart failure. Circulation 2003; 107: 1764-1769 – reference: 7) Tsuji Y, Opthof T, Yasui K, et al: Ionic mechanisms of acquired QT prolongation and torsades de pointes in rabbits with chronic complete atrioventricular block. Circulation 2002; 106: 2012-2018 – reference: 13) Varro A, Virag L, Papp JG: Comparison of the chronic and acute effects of amiodarone on the calcium and potassium currents in rabbit isolated cardiac myocytes. Br J Pharmacol 1996; 117: 1181-1186 – reference: 8) Volders PGA, Sipido KR, Vos MA, et al: Downregulation of delayed rectifier K+ currents in dogs with chronic complete atrioventricular block and acquired torsades de pointes. Circulation 1999; 100: 2455-2461 – reference: 4) Tsuji Y, Zicha S, Qi XY, et al: Potassium channel subunit remodeling in rabbits exposed to long-term bradycardia or tachycardia. Circulation 2006; 113: 345-355 – reference: 15) Kodama I, Kamiya K, Toyama J: Cellular electrophysiology of amiodarone. Cardiovasc Res 1997; 35: 13-29 |
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| Snippet | 症例は58歳, 女性. 主訴は動悸・息切れ. 55歳時に初回の心不全で入院. 冠動脈造影検査で有意狭窄なく, 心筋生検でも非特異的な所見のみ. HR 130/分台の頻脈性心房細動を... |
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| SubjectTerms | QT延長 アミオダロン カテーテルアブレーション 心室細動 頻脈性心房細動 |
| Title | 心房細動に対するカテーテルアブレーション後に心室細動を生じた低心機能の1例 |
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